F. Kanoun

Epidemic West Nile Virus Encephalitis in Tunisia

West Nile fever (WNF) is a mosquito-borne flavivirus infection. It is epidemic in Africa and Asia. In autumn 1997, a WNF epidemic occurred in the Sfax area (southeastern Tunisia). Fifty-seven patients were hospitalized with aseptic meningitis and/or encephalitis. Search for specific anti-West Nile virus (WNV) antibodies in serum and cerebrospinal fluid (CSF) was performed using an ELISA test. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the WNV genome in CSF and brain specimens. Recent central nervous system (CNS) infection by WNV was confirmed in 30 patients, probable infection in 17 and it was excluded in 10. In the confirmed subgroup, patients with encephalitis were older than those with meningitis. CSF showed pleocytosis, high protein (47%) and normal glucose levels. Brain computed tomography-scan (CT-scan) and magnetic resonance imaging (MRI) were normal. RT-PCR disclosed WNV genome in the CSF in two cases and in a brain specimen in one. Three patients died rapidly, the remaining cases had favorable prognosis. Autopsy was performed in two cases and showed nonspecific lesions of encephalitis. No viral inclusions were seen with light microscopy. Seropositivity rate in patients’ proxies for WNV was 23.4%. Prognosis of CNS involvement during WNF seemed to be poor in older patients. This is the first WNV encephalitis epidemic report in the Sfax area of Tunisia.

Angine de poitrine et fièvre boutonneuse méditerranéenne

Summary The authors report a case of an angina pectoris occurinG in the course of a mediterranean spotted fever. Recovery arose with antibiotics. Such a complication is very unusual.

Méningite à Streptococcus oralis après myélographie

Summary Bacterial meningitis is a rare complication of myelography.Viridans streptococci are responsible in must cases. The authors described a new case of meningitis due to Streptococcus oralis occurring more than 3 days after myelography in a 55 year old woman. The probable origin and the mechanism of infection are discussed.

Les modifications électrocardiographiques au cours de la fièvre boutonneuse méditerranéenne

Summary Mediterranean spotted fever is an eruptive disease caused by Rickettsia conorii . Endothelitis comes as a consequence of this infection. In this work we studied the electrocardiographic change of 9 patients with mediterranean spotted fever. Six had alteration of cardiac conduction. The pathogenic mechanism of vascular injury induced myocardial oedema. All patients with mediterranean spotted fever should be screened with an ECG.

Etude de la sensibilite des bacilles a gram negatif a l'hopital de Sfax

Resume Il sagit dune etude retrospective des prelevements bacteriologiques, sanguins et urinaires par hemoculture et uroculture, pratiquee au C.H.U. de Sfax. Cette etude sest etalee sur un an de 1985 a 1986. Nous avons reuni 4055 bacilles a Gram negatif. Leur sensibilite aux antibiotiques usuels a ete evaluee. Le taux de resistance aux antibiotiques couramment utilises est eleve. De ceci, une reflexion sur les consequences de lattitude therapeutique de premiere intention a ete proposee.